Chapter 16: Acute Lung Injury Following Inhalation of Irritant Products of Combustion

Injury from inhalation of smoke that contains both particulates and various irritant gases remains the most familiar cause of inhalational lung injury and is an important part of the management of burn injury. Smokes contain particulate matter and irritant gases, which cause damage at all levels of the respiratory tract. Apart from early damage to the large and small airways, acute lung injury (ALI) and acute respiratory distress syndrome, which affect the lung parenchyma, may ensue. These conditions have been the object of intense study over three decades, leading to a large amount of published specialised information. This chapter presents an outline of the pathophysiology and management of combustion inhalation injury for the non-specialist. There have been significant advances in management of ALI from the use of careful protective ventilation strategies. Pharmacological treatment measures have been studied in man and in large animal models for both combustion inhalation injury and the inhalation of toxic industrial chemicals, which have similar effects. The search for newer treatment strategies continues. A synopsis of current treatment measures is presented.